Diagnosis: Suffering


It wasn’t called PTSD, but “Shell-shocked”. I’ve seen archived articles referring to it this way, so clearly there was some understanding of the psychological impact of war, even though it went by a different name and had a more negative connotation to it.


I had begun crafting a more nuanced response to the Jones’ AEON essay. Yet, the more I wrote, the less satisfied I was with the focus of my comment. Actually, I became more dissatisfied with Jones’ essay which on further review I find to be ethereal - and not in a good way.

Although it may seem obvious and possibly trite in saying, it must be said that most people who endure a traumatic event will not subsequently develop the psycho-emotional or psycho-physical symptoms known as PTSD. That said, a not inconsequential number of people who survive a traumatic event - whether that “event” is virtually instantaneous (e.g.: a car crash) or occurs over a sustained period of time (e.g,: the Cleveland women held captive and tortured for years) or endure a trauma experience of middling duration - will subsequently develop the psycho-emotional and -physical dysfunctions identified symptomatically as PTSD.

Risking a belaboring of this fundamental point, I ask readers to imagine a circumstance where a person (one’s self or another) falls off of a bike, or collides with another while playing soccer or basketball or some other sort of abrupt impact that’s jarring an even painful. In a minority of such “accidents”, the persons involved end-up with more than a bruise or scrape. They end-up with concussions, broken bones or other painful (possibly life-threatening) injuries.

The point I’m belaboring is that bad outcomes are by far the minority in such incidents, yet we must not undervalue the importance of distinguishing the differences between types of outcomes.

In her essays on cancer and AIDs, Susan Sontag delved into the depths of the social pathologies that skew our ability to remain empathetic and rational when encountering both the visible and invisible attributes of illness. She cautioned that neither proportionality nor diagnostic ambiguity should be allowed to stain our compassion of others - whether well or especially when ill. Sontag’s essays in her book “Regarding the Pain of Others” lack the subtly but none of the sophistication of what are her “later” thoughts on these subjects in the “Metaphors…” volumes. What I do find to be a very useful way to understand the evolution of Sontag’s analysis from “Regarding” to “Metaphors” is to acknowledge that she, as a writer then cancer survivor, and “you” the the reader embody an accumulation of insights that - hopefully - facilitate greater acumen is distinguishing the boundaries between what one knows and that which is unknown (or not fully known) occupying he terrain beyond one’s “boundaries”.

I can admit to being a compatriot of Sontag in her anger and frustration when encountering artifices that conduce to the dehumanization of people - whether those artifices are intentionally or accidentally articulated. The seeds of my ire are rooted in an awareness of he history of human cruelty, medical ignorance and moral haughtiness. I am not suggesting - implicitly or explicitly - that all complaints be taken as sacrosanct. I am, I believe, urging Jones’ (admittedly at a distance) to revisit her own understanding of the scientific method because it seems to me that she - and those who find wisdom in or sympathize with her views - applies the mechanics of scientific investigation in a manner that is literally backward.

Scientific inquiry, into which I’ll fold medical inquiry begins with doubt. But, crucially, what kind of doubt.

The doubt that fuels science and rational inquiry resides in an epistemology that takes as suspect one’s own view, one’s own perspective(s) of the world before you. Through the act of questioning and the exercise of the rules of logic and evidence, a “scientifically” inclined investigator corrals her biases along with the extraneous data the world (or source) broadcasts in service of clearing the space from an empirically sound truth to be derived. It is from these principles (which are I’m not articulating particularly well), that I find Jones’ essay wanting as a reliable critique of a medical condition. I do, however, find her prose to be interesting as an example of an insidious displacement of rational inquiry for a rationalism that fits Sontag’s definition of punitive moralizing.

Lastly, though possibly not finally, I must remark on a peculiarity our age. That is that the preponderance of reactions to demonstrations of anxiety by individuals prompts veritable flash-mobs of anxious and angry - often irrational - condemnations. Could it be that we are all emperors, naked save our all too obvious anxieties? Could it be that naked expressions of anxiety’s ill affects reminds us that we too have the disease but believe ourselves to be asymptomatic?


Much of the discussion (in the media) regarding PTSD pertains to people who have served in the military, and their combat experiences. This leaves out the non-military people who have have experienced a traumatic event like a violent crime or life threatening event like an accident or disaster. There is a large group of people who are regularly excluded from the discussions on PTSD - the survivors of sexual assault and domestic violence. Statistically - this is a much larger group of survivors.

To further compound the diagnosis/discussion - there is PTSD - which refers to one violent, life threatening or other traumatic experience - but there is also ©PTSD. Complex Post Traumatic Syndrome is what happens to a person who has endured an ongoing situation of trauma - like a hostage taking, or a person living with a violent partner/spouse. The manifestations of this are similar to PTSD but also diverge.

PTSD and ©PTSD are devastating conditions that are often regarded dismissively, even by professionals within the medical profession. PTSD has also entered the ordinary vernacular - so people will claim that “a tough exam gave them PTSD” for example.


I realize this is journalism and not science. But I’m afraid a lot of readers don’t understand the difference, and will take this string of anecdotes as “proving” some point or other. Just like there are people desperate to prove that racism doesn’t exist, there are others just as eager to dismiss the reality of any kind of mental illness short of outright psychosis. This article doesn’t do that, but it sure will give those folks ammunition.

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I knew that we were in trouble when Jones led with an anecdote about her grandfather, who apparently sailed through the Great War with his chin up, and pretty much gave up when she proffered that PTSD didn’t exist as a diagnosis forty years ago. Neither did AIDS, but that has its well-credentialed denialists, too.


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